NPIMap

Organization Active NPI

Athens Kidney Center, PC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Athens, GA
National Provider Identifier
1831286228
Registry record updated Dec 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
ESRD000999 Issued in GA
Legal business name
ATHENS KIDNEY CENTER, PC
Practice address
1440 N Chase St
Athens, GA 30601-1850
Phone
(706) 543-6397
Fax
(706) 227-2116
NPI assigned
Oct 6, 2006
Last updated
Dec 26, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Azubueze Afam Adogu, M.D., PH.D.NPI 1518905959
Title
President
Phone
(706) 543-6397

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X ESRD000999 GA Primary

Addresses

Primary practice location

1440 N Chase St
Athens, GA 30601-1850

Mailing address

1440 N Chase St
Athens, GA 30601-1850
Phone (706) 543-6397

Other identifiers 2

IdentifierTypeStateIssuer
000731618EMedicaidGA
000731618DMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130719000748 GA Part A Provider - End-Stage Renal Disease Facility (ESRD) 9739127036 Practice locations: Athens, GA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Athens Kidney CenterCCN 112674
Overall star rating
1.0 of 5
Ownership
Profit
Certified
Feb 4, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
18

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1056455Athens Kidney Center1440 North Chase Street, Athens, GA 30601Certificate of waiverJul 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
Oconee Medical Group5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1440 N Chase St
Athens, GA 30601
Phone (706) 227-2110

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1230249600000",
    "number": "1831286228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 N CHASE ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306011850",
            "telephone_number": "706-543-6397",
            "fax_number": "706-227-2116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 N CHASE ST",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306011850",
            "telephone_number": "706-543-6397",
            "fax_number": "706-227-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENS KIDNEY CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2008-12-26",
        "status": "A",
        "authorized_official_last_name": "ADOGU",
        "authorized_official_first_name": "AZUBUEZE",
        "authorized_official_middle_name": "AFAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-543-6397",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D., PH.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "GA",
            "license": "ESRD000999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000731618E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000731618D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.